10779/rcsi.10772198.v1 Anthony J. Montgomery Anthony J. Montgomery Hannah McGee Hannah McGee William Shannon William Shannon John Donohoe John Donohoe Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study. Royal College of Surgeons in Ireland 2019 Age Factors Creatinine Decision Making Factor Analysis Statistical Family Practice Female Humans Interviews as Topic Ireland Kidney Failure Chronic Male Marital Status Medicine Middle Aged Nephrology Physician's Practice Patterns Questionnaires Referral and Consultation Renal Dialysis Specialization Urology Psychology and Cognitive Sciences not elsewhere classified 2019-11-22 15:36:15 Journal contribution https://repository.rcsi.com/articles/journal_contribution/Factors_influencing_general_practitioner_referral_of_patients_developing_end-stage_renal_failure_a_standardised_case-analysis_study_/10772198 <p>BACKGROUND: To understand why treatment referral rates for ESRF are lower in Ireland than in other European countries, an investigation of factors influencing general practitioner referral of patients developing ESRF was conducted.</p> <p>METHOD: Randomly selected general practitioners (N = 51) were interviewed using 32 standardised written patient scenarios to elicit referral strategies. Main outcome measures: General practitioner referral levels and thresholds for patients developing end-stage renal disease; referral routes (nephrologist vs other physicians); influence of patient age, marital status and co-morbidity on referral.</p> <p>RESULTS: Referral levels varied widely with the full range of cases (0-32; median = 15) referred by different doctors after consideration of first laboratory results. Less than half (44%) of cases were referred to a nephrologist. Patient age (40 vs 70 years), marital status, co-morbidity (none vs rheumatoid arthritis) and general practitioner prior specialist renal training (yes or no) did not influence referral rates. Many patients were not referred to a specialist at creatinine levels of 129 micromol/l (47% not referred) or 250 micromol/l (45%). While all patients were referred at higher levels (350 and 480 micromol/l), referral to a nephrologist decreased in likelihood as scenarios became more complex; 28% at 129 micromol/l creatinine; 28% at 250 micromol/l; 18% at 350 micromol/l and 14% at 480 micromol/l. Referral levels and routes were not influenced by general practitioner age, sex or practice location. Most general practitioners had little current contact with chronic renal patients (mean number in practice = 0.7, s.d. = 1.3).</p> <p>CONCLUSION: The very divergent management patterns identified highlight the need for guidance to general practitioners on appropriate management of this serious condition.</p>